Clostridium Difficile Infection Associated With Higher Mortality Rates in Patients With Cirrhosis

Clostridium difficile infection leads to higher rates of overall mortality among patients with cirrhosis compared to those who do not, according to a study presented by lead-author Russel Rosenblatt, MD, department of medicine, Weill Cornell Medicine, at the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 9-13, 2018, in San Francisco, California.

“Patients with cirrhosis are vulnerable to C diff infection, frequent bacterial infections, and dysbiosis due to their functional immunosuppression,” the investigators of the study wrote. “Despite data demonstrating that C diff infection is becoming more common and is associated with a higher mortality in patients with cirrhosis, there is no data assessing its recurrence and readmissions in this patient population.”

Data were collected from Washington, Florida, and New York State Inpatient Databases (SID) between 2009 to 2013 for the study. To be included in the analysis, patients must have had an International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code consistent with cirrhosis or its complications, including ascites, esophageal varices, hepatic encephalopathy, and hepatocellular carcinoma. Patients who underwent prior liver transplant were excluded from the study.

The primary endpoint was hospital readmission within 30 and 90 days, with secondary endpoints of total inpatient morality and multiple readmission.

Of the 123,546 patients meeting the criteria for eligibility, 1,827 (1.5%) had C diff infection and 121,719 (98.5%) did not. The study identified notable higher rates of mortality among patients with C diff at index admission than those without C diff infection (17.9% versus 7.4%, respectively; P<.001).

For patients who did not die or who were transplanted at index admission, those with C diff infection had higher admission rates within 30 days compared with those without C diff infection (21.1% versus 19.3%, respectively; P = .03). However, the percentage of patients who readmitted within 90 days of index admission were similar between the 2 arms (31.7% versus 30.2%, respectively).

“Index and subsequent admissions for C diff infection has significant consequences for patients with cirrhosis,” the investigators wrote.

The readmission rate with C diff infection at 30 days was 17.2% for patients who presented with C diff infection at index admission compared with 0.8% for those who did not (P<.001). Similar rates were noted at 90 days (21.7% versus 1.1%, respectively; P<.001), and inpatient death during readmission.

Higher overall mortality was seen for patients with C diff infection at index admission (24.0% versus 13.1%, respectively; P<.001); however, there were no significant differences noted in overall readmission rates.

“Prevention, early recognition, and aggressive treatment strategies need to be reexamined for those patients with cirrhosis and C diff infection to prevent deleterious consequences,” the investigators concluded.

The study is entitled, “The Effect of Clostridium Difficile Infections on Readmissions in Patients with Cirrhosis.”